Medical Bill Auditor

WSI believes that every worker deserves a safe work environment, and every employer deserves to have their workers safe on the job, without the risk of a workplace injury. WSI is dedicated to creating a safe, secure, and healthy North Dakota workforce. WSI received the Bismarck-Mandan Young Professionals Network Top 10 Workplace awards in 2017 and 2023. Our team members share our core values of being loyal, caring, and forthright. These values and the servant leadership philosophy guide our organization and help us stay true to our purpose to care for injured workers. Hiring Salary: $3,600per month plus the state benefits package, including a paid family health insurance plan and 10 paid holidays. This position is a Monday-Friday day position located in the Bismarck Office and is eligible for remote work on a hybrid schedule after the successful completion of probation. If an external candidate (not currently employed with the State of ND) is selected for this position they may be eligible for a hiring bonus of up to one month's salary. Summary of Work Workforce Safety & Insurance is seeking a Medical Bill Auditor to review, process, and audit submitted medical billings to ensure appropriate reimbursement by WSI. The Medical Bill Auditor creates value and makes an impact with these job duties: Review and process medical bills according to national coding guidelines and established policies and procedures. Review medical documentation to confirm correct medical codes are submitted on the billed charges and documentation supporting the compensable injury. Confirm prior authorization requirements are met for services provided as appropriate. Ensure the WSI fee schedule or contracted agreement rate is applied correctly. Process approved adjustments and reconsideration requests; initiate adjustments when audit findings merit such action. Reporting suspected fraud and abuse. Maintain medical bill review manuals, policies, and procedures to ensure they reflect current laws and regulations. Review new medical procedures, technology, equipment, and medical codes to recommend coverage and reimbursement levels to the supervisor. Respond to provider inquiries with questions relating to coding, documentation, procedures, and payer requirements. Resolve provider reimbursement payment issues. Minimum Qualifications To prosper in this position, an associate degree in a health-related field and two years of work experience processing, auditing, or coding medical claims. Relevant work experience in processing, auditing, or coding medical claims may substitute for the education requirement on a year-for-year basis. Preferred Qualifications Current CPC Certification (Certified Professional Coder) or CPC certification eligible. Knowledge of the insurance industry, therapy coding, billing, or documentation. Confident, articulate, and professional verbal and written communication skills. Detail-oriented, problem-solving, and decision-making abilities. Dependable, organized, self-motivated, resourceful, and flexible. WSI holds our agency culture in high regard. The desired applicant must be engaging, professional, confident, forward-thinking, and supportive. About Team ND "Far and away the best prize life offers is the chance to work hard at work worth doing." - Theodore Roosevelt More than 7,500 talented, hard-working people across sixty-three agencies have come together as Team North Dakota. At Team ND, we are driven to succeed through gratitude, humility, curiosity and courage. Our purpose is to empower people, improve lives, and inspire success. Join us in being legendary.Total Rewards: The State of North Dakota is committed to providing team memberswith a strong and competitive rewards package that support you, your health and your family.Considering a new position on Team ND? How does your current position stack up? Use our Total Rewards Calculator to estimate. Application Procedures Apply online and upload the following information: cover letter (addressed to Human Resources), resume, references, and copy of college transcripts (if applicable). All application materials must be received by the closing date to be considered for the open position. Background checks will be conducted. WSI staff will score all applications based on a 100-point scoring and rating system. Applications should include information that directly addresses how the applicant meets the minimum qualifications and a summary of work. It is very important to be thorough and detailed in the application materials. Incomplete sections in the application will not be given credit. Applicants with disabilities should contact Denise Osmond at 701-328-3849 in advance of applying to discuss any special provisions needed for applying or interviewing. If you are experiencing technical difficulties with the Application Process or uploading attachments,please contact recruiter@nd.gov or 701-328-3290. ND Relay Number 1-800-366-6888. Equal Employment Opportunity The State of North Dakota and this hiring agency do not discriminate on the basis of race, color, national origin, sex (including sexual orientation and gender identity), genetics, religion, age or disability in employment or the provisions of services and complies with the provisions of the North Dakota Human Rights Act.As an employer, the State of North Dakota prohibits smoking in all places of state employment in accordance with N.D.C.C. § 23-12-10.